What You Should Know About Gout And Pregnancy

Gout is a kind of arthritis. It features painful swelling in joints, especially joints of the extremities, such as the big toe. The cause of gout is a buildup of crystals of a chemical compound called uric acid. Uric acid is produced as the result of the breakdown of chemicals called purines, which are among the building blocks of DNA and also ATP, the energy-carrying molecule of body cells. Abnormally high purine levels, due to dietary factors or genetic factors, and problems excreting uric acid from the body, can lead to an excess of purines and thus to uric acid buildup. On account of genetics, people vary in how susceptible they are to developing gout. The disease can be chronic, which means that it comes and goes over many years, showing up as painful nodules under yellowed regions of skin. Acute gout is a more severe condition in which the person suffers sudden gout attacks with severe joint swelling and pain.

The first step in diagnosis of gout is your history and physical examination, which will tell doctors whether there are signs of gouty joint inflammation, such as yellow skin, sometimes with red areas and with nodules in affected joints that have a limited range of motion. Fever is common and affected joints also tend to be warm. Typically, the person reports pain that is so severe that it hurts even to have the blankets and sheets push on the affected joints. To make a diagnosis, your physician will insert a needle into an affected joint and draw out fluid that can be examined for birefringent monosodium urate crystals. X-ray images also may be taken of the affected joints.

Although gout develops in about 3 to 34 out of 1,000 people, the disease is less common in women of reproductive age compared with older women and men. If gout runs in your family, there is a risk that you can develop gout symptoms during pregnancy. Other risk factors for gout include diabetes, obesity, high blood pressure, metabolic syndrome, hyperlipidemia (high levels of LDL cholesterol and triglycerides in your blood), use of certain medications, and a diet rich in high-urine foods, meaning meat (red meat, poultry, fish), organs (heart, kidney, liver, sweetbread, gizzards), spinach, yeast extract, lentils, beans (especially soybeans, lima beans, kidney beans, northern beans, white beans, and black-eyed beans).

One problem that gout causes is pain, especially in the legs and feet, so it can lead to disability, such a walking problems, that can worsen throughout pregnancy. The underlying gout itself can worsen during pregnancy on account of hormonal changes causing more uric acid to accumulate. There is evidence that high uric acid levels during the first trimester can lead to a severe pregnancy complication, preeclampsia, later on in pregnancy. Preeclampsia increases the risk of premature birth and abruptio placentae or placental abruption (detachment of the placenta from the uterine wall), which can lead to death of the fetus, stillbirth, or neonatal death just after birth.

Although gout develops in about 3 to 34 out of 1,000 people, the disease is less common in women of reproductive age compared with older women and men. If gout runs in your family, there is a risk that you can develop gout symptoms during pregnancy.

Along with dietary changes, gout is treated with medications to stop gout attacks. These include non-steroidal anti-inflammatory drugs (NSAIDs), cyclooxygenase 2 (COX2) inhibitors, colchicine, and corticosteroids. Medications also include agents for controlling uric acid levels, such as colchicine, allopurinol, febuxostat, and probenecid. Some of these medications, such as NSAIDs, carry some risks for the fetus. In particular, NSAIDs should not be given late in pregnancy because they can cause premature closure of the ductus arteriosus, a passageway that allows blood to flow from the pulmonary artery to the aorta while the fetus is inside the womb. Other medications, such as corticosteroids, are generally safe during pregnancy. Allopurinol is considered safe during pregnancy, although it should be used with caution during the first trimester.

Dietary changes to counter gout include eliminating alcohol, a move that is also recommended for pregnancy. Patients also are recommended to reduce the intake of a kind of sugar called fructose, which is present in all fruits, but is in particularly high levels in mangoes, apples, cherries, watermelon, and pears. Berries tend to have less fructose. As for avoiding an ingredient called “high-fructose corn syrup” (HFCS), doing so often leads people to consume more fructose than they would consume if they did not avoid HFCS. The reason is that the most common type of HFCS used in sweetened drinks, HFCS-42, is 42 percent fructose, while cane sugar, which is often marketed as a “healthy”, “natural”, or “organic” substitute for HFCS, is 50 percent fructose. A better strategy is to limit your consumption of sweets, including juices, whether they have HFCS or not.

Along with dietary changes and medication, gout can be treated with a procedure called joint aspiration. In this procedure, a needle is inserted into affected joints to remove fluid.

Gout can be particularly problematic for those mothers who plan to breastfeed because many of the drugs given for gout can enter breast milk, so there is concern that they can reach the nursing infant. In some cases, the easiest solution is to avoid breastfeeding and choose an infant formula instead. Sometimes women whose gout is controlled with a corticosteroid called prednisolone are recommended to wait a few hours after receiving the treatment as the prednisolone builds up in the milk. Then, they can pump and discard the milk and wait for the concentration of prednisolone to decrease. In many cases, it may be difficult to supply enough breast milk with this strategy to nourish the infant exclusively with breast milk.

David Warmflash
Dr. David Warmflash is a science communicator and physician with a research background in astrobiology and space medicine. He has completed research fellowships at NASA Johnson Space Center, the University of Pennsylvania, and Brandeis University. Since 2002, he has been collaborating with The Planetary Society on experiments helping us to understand the effects of deep space radiation on life forms, and since 2011 has worked nearly full time in medical writing and science journalism. His focus area includes the emergence of new biotechnologies and their impact on biomedicine, public health, and society.

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